Given the disparity between the number of patients who would benefit from a kidney transplant and the supply of donor organs, there is interest in expanding the donor pool. However organ quality is adversely affected by increasing donor age and other characteristics such as hypertension or stroke as a cause of death. Some patients may still benefit from accepting such organ offers in exchange for shortening their waiting time to kidney transplantation. This challenges programs to identify and educate transplant candidates regarding the relative risks and benefits of accepting such kidney offers. Optimizing management of expanded criteria donors, the organs they donate, and the recipients transplanted with these organs remains a priority for transplant programs. This session will review the issues regarding the use of expanded criteria donor organs.